环境健康安全评估资料提供表Document Requisition List for EHS Assessment请参照下表准备好贵厂相关管理文件、许可证及记录，并提供给现场评估人员评审。

The facility should prepare and provide available documents, records or permits/licenses as per the following list, which will be reviewed during the EHS assessment.类别Category 工厂相关政策，文件及管理程序Factory policies, procedure and documentation若具备(√)If Available (√)提供复印件（√）If Copy provided （√）说明Remark1．基本信息General 工厂名称、地址、运营历史Facility name, address, and history 厂区平面布置图(电子版) Site layout plan （Electronic）产品信息与生产规模（现在的和历史的）Production information and scale (current and historical)生产工艺流程图Production flow chart建筑物台帐，包括面积，层数，建筑时间，功能等Building Record including area, floor, age, and operation.员工数量及生产作息规程Employee quantity and operation time and shift工厂电、水、燃气、蒸汽等供应及使用信息Information on supply and use of electricity, water, gas, steam, etc. 工厂环境健康安全管理规程、培训手册及记录EHS management procedure, training manuals and records相关的管理体系认证(ISO 9000, ISO22000等)Correlative Management System Certificates2．场地背景Site setting 场地周边使用情况Surrounding land use场地以前的环境调查报告（土壤、地下水、大气、石棉等）Previous environmental investigation reports(soil, groundwater, air emission, asbestos, etc.)所在工业园区的介绍册（如适用）Industrial Zone Introduction (if applicable)3. 环境许可Envir. Permitting 建设项目环境影响评价报告书或报告表Environmental Impact Assessment (EIA) report or form建设项目环境“三同时”验收监测报告，验收批复“Three synchronies” monitoring report and approval forms 年度污染物登记报表(包括废水、废气、固体废物和噪声) Annual Pollution Discharge Registration Form(for air, wastewater, noise and solid waste)污染物排放许可证(包括废水、废气、固体废物和噪声) Pollutant Discharge Permit (air, wastewater, noise and waste)4．废气Air emission 废气源清单（含产生量和主要污染物）Air emission sources including volumes and major pollutants 废气排放口数量Number of air emission point(s)Category Factory policies, procedure and documentation If Available (√) If Copy provided （√）Remark 废气排放监测报告Air emission monitoring documents废气处理设施清单（如油烟分离，过滤器，文丘里等）Air emission treatment facilities5．噪音Noise 噪声源清单Noise sources边界噪声监测报告Boundary noise monitoring documents噪音减缓设施清单及规格说明（如消声器，隔音罩等）Noise abatement facilities (including muffler, sound isolation cover)6．水与废水Water and wastewater 厂区排水系统平面图Pipeline Layout取水许可证（如适用）Surface Water Abstraction Permit地下水井信息（如适用）Groundwater well information最终雨水去向及最终雨水排放口数量Stormwater receptor and number of final discharge point(s)最终废水去向及最终废水排放口数量Wastewater receptor and number of final discharge point(s)废水源清单（含产生量和主要污染物信息）Wastewater sources including volumes and major pollutants污水排放协议Wastewater discharge agreement污水排放监测报告Wastewater discharge monitoring documents污水处理设施清单及规格说明（如污水处理站，化粪池，隔油池）List of wastewater treatment facilities污水处理站污泥的最终处置方式或去向（如适用）Final treatment means or destination of sludge from WWTP废水外包处理合同及处置商资质（如适用）Wastewater out-sourced treatment contracts and vendor licenses7．废物处理Waste handling 一般废物与危险废物清单与数量General waste and hazardous waste inventory with quantities 废物处置合同及废物处置商资质Waste disposal contracts and vendor licenses危险废物转移五联单Hazardous waste transfer manifest (five-sheet)废物最终处置方式或去向Final treatment means or destination of wastes危险废物处理员培训记录Training records for hazardous waste handlers8．化学品Chemicals 原材料清单与数量（含化学品与危险化学品）Raw materials inventory with quantities (including general chemical and dangerous chemical)危险化学品的安全技术说明书（MSDS）MSDS of dangerous chemicalCategory Factory policies, procedure and documentation If Available (√) If Copy provided （√）Remark 化学危险品仓库审批许可证剧毒物品使用许可证（氰化物等）登记及储存纪录Approval certificate of chemical warehouse厂区地上及地下储罐清单及分布（现在使用的和废弃的）Aboveground & underground storage tanks (current and historical)化学品储存情况纪录Register / storage record of chemical goods危险化学品管理员培训记录Training records for staff managing dangerous chemicals化学品溢出、泄漏等环境事故应急预案和记录Records of environmental incidents and emergency actions takenregarding spills, leaks, air emissions etc9．有害物质Deleterious Materials 保温隔热材料类型Type of heat-isolation materials制冷系统制冷剂类型Refrigerant type of refrigerating system 灭火器类型（1211, CO2, 干粉等）Extinguisher type (Hallon, CO2, powder, etc)10．安全Safety 相关的安全许可证（包括安全评价报告，三同时竣工验收报告等）Safety permitting documents (including SIA reports, “Three synchronies” approval s)避雷接地检测报告/合格证Grounding and thunder/Lightning protection testing certificate安全生产管理人员培训证书Safety manager certificate特种设备台帐（包括锅炉、压力容器、电梯、叉车等），使用许可证及定期检查记录Special equipment inventory (including boiler, pressure vessel, elevator, and etc.), certificate and regular inspection record特种作业人员操作证，如叉车,电梯,焊接,电工,锅炉,危险化学品,高处作业等Specialized safety training certificate11．消防Fire-fighting 消防验收报告Fire inspection records消防管理人员上岗证Fire officer certificate灭火器/消防栓/警报系统的定期检查及维护纪录Fire extinguisher / hydrant / alarm system / fire fighting system inspection and maintenance records消防通道指示/应急灯等定期检查及维护纪录Fire exit indicators/emergency lights inspection and maintenance records消防演练的记录或者文件Fire drill program/record紧急逃生程序Emergency evacuation plan12．工业卫生Industrial Hygiene 职业健康影响评价与控制效果预评价Occupational Health Impact Assessment (HIA) & Control Effectiveness Assessment (CEA)Category Factory policies, procedure and documentation If Available (√) If Copy provided （√）Remark 职业病危害申报登记Registration form and approval letter of Occupational Hazard车间工业卫生监测报告(包括有毒有害作业岗位，高噪音区等) Industrial hygiene monitoring report员工职业病监护程序及体检报告Medical surveillance program and record急救训练纪录，以及急救人员证书First aid training record, Trained first aider certificate个人劳动保护用品分发计划及记录，供应商安全鉴定证PPE distribution plan and record, supplier’s certificate。